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Prof. Hester Vermeulen PhD, RN Dewi Stalpers PhD, RN-ICU “A nurse is a nurse is a nurse?” Skills level differentiation in the Netherlands

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Prof. Hester Vermeulen PhD, RN

Dewi Stalpers PhD, RN-ICU

“A nurse is a nurse is a nurse?”

Skills level differentiation in the Netherlands

Short introduction

• Nurse, Academic Medical Center (AMC)

• Master Evidence Based Practice; Clinical Epidemiology

• PhD Evidence Based Postoperative Care

• Professor Radboud University/ IQ healthcare

• ICU nurse, St. Antonius Hospital

• Master Health Sciences

• PhD Excellent Care

• Advisor/researcher Dutch Hospital Association (NVZ)

Aim of the presentation

• Overview current Dutch nursing workforce

• Future perspectives

• Impact on all health care fields, we focus on hospitals

Health care workforce in the Netherlands

Nursing workforce

• ±180.000 nursing professionals

• ± 80.000 in hospitals

EQF (Europe)> NLQF (Netherlands)

• NLQF 2/3: Nurse assistant

• NLQF 4: Vocational level nurse

• NLQF 6: Bachelor level nurse

• NLQF 7: Nurse specialist/Physician Assistant

• NLQF 7/8: Academic nurse (Master/PhD)

Current developments

• Since 2012 awareness to look at current and future Dutch workforce

• Research of e.g., RN4CAST:

• Staffing and skill-mix

• Nurse-sensitive patient outcomes

(Patient safety & Care Left Undone)

• Nurse outcomes

(Burnout, intention to leave)

Changes in society

From now to 2030

• More complex patients (age, multi-morbidity)

• More chronic, psychic and psych-social problems

• Emphasis on chain care (intersectional/ inter-professional)

• Centralisation of high-technology and complex care in hospitals

Changes in patient approach

Positive health

• Focus on functioning instead of the disease

• Biomedical to biosocial model

New definition (Machteld Huber):

“The ability to adapt and to self manage in the light of the physical, emotional and social

challenges of life "

Changes for professionals

Future developments in health care

• Professional competence

• Collaborative ability

• Permanent learning capacity

• Role for technology

Quality impulse (KiPZ)

Quality Impulse Hospital Personnel

(2014-2017)

• “Recruit and retain skilled and engaged workforce by allowing an extra boost to the qualifications and training of employed professionals”

• Subsidy from Department of Health, Welfare & Sports

• Strategic planning of personnel and training

• CPD: E-Health, renew skills, practice labs

upgrade education level, EBP implementation

Recent debates

• Education, staffing, skillmix

• Nurses NLQF 4 & 6:

• In nursing practice equal functions

• Equal nursing procedures

• Advice to make a differentiation:

• NLQF 4 nurse

• NLQF 6 nurse

• Amendment of the law in 2018/2019

https://peppermint.wistia.com/medias/l5nula9dxi

Consequences

Job profiles

NLQF 4 nurse

• Optimization care process patient

• Coordinates nursing aspects around individual patients

• Provides contribution to quality of nursing care (eg workgroup)

NLQF 6 nurse

• Optimization care process patient group

• Coordinates nursing aspects surrounding patient flows

• Initiates and monitors quality of care (eg setting up research)

Actually differentiate in practice

Coaching

Clinical reasoning

Evidence Based Practice

https://www.nvz-ziekenhuizen.nl/onderwerpen/functiedifferentiatie-mbo-en-hbo-verpleegkundigen

Skill-mix - MBO, (post-)HBO - (post-) academic Continu Prof Development - formal & informal

Evidence Based Guidelines Nursing process - Assessment, diagnosis,

outcomes, planning, implementation, evaluation

Nurse Sensitive Outcomes - Patient - Professional - Organizational

Earlier research

So we have to move from…. to…

Fig. 2

Natalie Taylor, Robyn Clay-Williams, Emily Hogden, Jeffrey Braithwaite and Oliver Groene High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Services Research201515:244

High Performing Organizations

Empirical framework

Modified from O’Brien-Pallas et al., J Clin Nurs. 2011;20:1640-1650

Demand for care · Patient characteristics

age, gender, comorbidity, etc. · Number of patients

Patient outcomes · Complications · Nurse sensitive outcomes · Satisfaction and patient reported outcome measures (PROMS)

Personnel outcomes · Job satisfaction ·Absenteeism ·Burnout ·Professional practice

Organizational outcomes ·Quality of care ·Costs

Staffing · Care-givers age, gender, experience,

employment status · Number of care-givers · Skill mix

Organization of care · Organizational

characteristics type, size, technology

· Structures, models and conditions for providing care

Processes on ward level (what really happened; non predictable; erratic) ·Patient care intensity ·Staffing utilization level ·Percieved work environment

Caregivers’ workload

Feedback

Catharina van Oostveen, RN PhD, Prof. Hester Vermeulen

Clinical Academic Career Pathways

Now • Lack of career possibilities • Recruitment and retention not optimal • Not an optimal infrastructure for research • Knowledge drain Desired combination of core tasks

• Research & Practice • Practice & Education • Education & Reseach

Clinical Academic Career Pathways

P

E R

Clinical Academic Career Pathways

Nursing Career Path in Research

at the NIH Clinical Center, America

Clinical academic training pathway

of the University of Southampton

- Visualize the career opportunities for nurses - Contribute to the development of clinical academic nurses - Increase image of hospital as an attractive employer - Increase staff retention which reduce labour cost - No waste of talent!

P

E R

A Dutch version of CA Pathways

Skills level differentiation

Not a goal in itself, but a mean…

• …to optimize quality of patient care

• …to provide good work environments in which all nurses excel on their own level

• …to create efficient and collaborative teams

Thank you for your attention!